Dental treatment method and abutment used therein

ABSTRACT

A dental treatment method is provided. In this method, a tooth of a patient is extracted and prepared to provide a root part. A root canal in the extracted tooth is prepared and treated. A post of an abutment is fitted into the root canal to attach the root part to the abutment. The abutment having the root part is attached to a dental implant. With the root part attached to the abutment, periodontal connective tissue maintains the jaw bone associated with the extracted tooth, without significant hard tissue loss.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of a co-pending application having U.S.Ser. No. 14/775,257, filed on Sep. 11, 2015, which is a 371 ofInternational application having Serial No. PCT/US2014/027691 filed onMar. 14, 2014, which claims benefit of U.S. Provisional Application No.61/784,118 filed on Mar. 14, 2013, the entire contents of which areincorporated herein by reference.

BACKGROUND

The present disclosure relates generally to dental implants, and, moreparticularly, to an abutment and a dental treatment methodology, whichenables a professional to use autologous, preexisting tissue from toothextraction for immediate or delayed implant placed accompanied by aprosthetic restoration.

Dental implants are becoming a preferred procedure among patients whowant more durable, permanently looking teeth. From 1983 to 2008, dentalimplant procedures performed in the United States increased 10-fold,increasing to $150 million dental implants placed in 2008 compared to$10 million in 1988. To date, about 3 million Americans have availedthemselves of dental implants and that number is growing by 500,000 peryear, according to data from the American Academy of Implant Dentistry.

The basic function and osseointegration of the modern implants isachieved in most cases today. It is the more complex esthetic casesespecially in the anterior with a limited bone volume where dentalimplants show their limitations. If a tooth is extracted in the anteriormaxilla, the surrounding thin bone will be resorbed due to the surgicaltrauma and the lack of natural force induction. Even an immediatelyplaced implant does not prevent this bone loss. Accordingly, many ofthese implants result in a soft tissue recession caused by the boneloss. This can be esthetically challenging and easily end up in mediocreresults. Today, a separate bone augmentation procedure is necessary inmany of these cases, in order to achieve a satisfying outcome. Accordingto the increased demand of implants in the esthetic area, there is aneed for improved implant techniques and procedures demanded by patientsand dentists.

SUMMARY

According to an exemplary aspect of the present disclosure, a dentaltreatment method is provided. The method includes extracting a tooth ofa patient; preparing the extracted tooth to provide a root part havingautologous tissue; attaching the root part to an abutment, andconnecting the abutment to a dental implant. For example, the abutmentcan be a standard premanufactured abutment or a customized abutment.

According to another exemplary aspect of the present disclosure, amethod of manufacturing an abutment for a dental implant is provided.The method includes obtaining data associated with the dentition of apatient; generating a model of the abutment through acomputer-implemented process based on the data; and processing amaterial based on the model to generate the abutment, % herein theabutment is configured to match the analogue of a predetermined tooth ofthe patient, such that, after the predetermined tooth is extracted andprepared to provide a root part, the root part is attached to theabutment during osseointegration.

According to still another exemplary aspect of the present disclosure,an abutment for a dental implant is provided. The abutment includes anapical end and a coronal end opposite the apical end; an insertionportion at the apical end, the insertion portion being configured to bereceived in an opening of the dental implant; a transition portioncoronal of the insertion portion; and a connecting portion extendingcoronally from the transition portion. The connecting portion isconfigurable to be attached to a root canal or a tooth structure, whichis resected from an extracted tooth of a patient.

These and other aspects and advantages of the current disclosure willbecome apparent from the following detailed description considered inconjunction with the accompanying drawings. It is to be understood,however, that the drawings are designed solely for purposes ofillustration and not as a definition of the limits of the disclosure,for which reference should be made to the appended claims. Moreover, thedrawings are not necessarily drawn to scale and, unless otherwiseindicated, they are merely intended to conceptually illustrate thestructures and procedures described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a flow chart illustrating a dental treatment method accordingto an exemplary aspect of the disclosure;

FIG. 2 is an illustration of an X-ray scan, showing an image example ofa patient's dentition captured through the scan:

FIG. 3 is an illustration of an X-ray scan, showing an image example ofan extracted tooth having a root part which will be separated from theextracted tooth;

FIG. 4 is a bottom perspective view, showing an abutment according toanother exemplary aspect of the disclosure, which has a customizedshoulder portion fitting precisely to the shape of the extracted toothroot:

FIG. 5 is an illustration showing an implant and the abutment, prior tothe connection of the abutment to the implant; and

FIG. 6 is an illustration showing the implant and the abutment (with theseparated tooth root attached to the abutment), after the connection ofthe abutment to the implant.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

Detailed embodiments of the present disclosure are described herein;however, it is to be understood that the disclosed embodiments aremerely illustrative of the compositions, structures and methods of thedisclosure that may be embodied in various forms. In addition, each ofthe examples given in connection with the various embodiments isintended to be illustrative, and not restrictive. Further, the figuresare not necessarily to scale, some features may be exaggerated to showdetails of particular components. Therefore, specific structural andfunctional details disclosed herein are not to be interpreted aslimiting, but merely as a representative basis for teaching one skilledin the art to variously employ the compositions, structures and methodsdisclosed herein. References in the specification to “one embodiment”,“an embodiment”, “an example embodiment”, etc., indicate that theembodiment described may include a particular feature, structure, orcharacteristic, but every embodiment may not necessarily include theparticular feature, structure, or characteristic. Moreover, such phrasesare not necessarily referring to the same embodiment.

In this disclosure, replantation means the surgical reattachment of abody part by microsurgical means, most commonly a tooth that has beencompletely avulsed from a person's body. An autologous procedure meanstransplantation of organs, tissues or even proteins from one part of thebody to another in the same individual. Tissue transplanted by theautologous procedure is referred to as an autograft or autotransplant.Auto-alloplastic implant means intentional reimplantation of anautologous tissue like a tooth with extraoral insertion of an implant(auto-alloplastic reimplantation).

FIG. 1 is a flow chart illustrating steps of a dental treatment method100 according to an exemplary aspect of the disclosure.

At step 102, an X-ray scan is conducted to obtain data associated withthe dentition of a patient, who can be adult females or males suitablefor treatment with implant supported restoration at least partially inthe maxilla, preferable at the age between 21 and 70. For example, theX-ray scan can be a 3D X-ray scan, such as Cone Beam Computer CT (CBCT)or classic CT. During this procedure, the field of view of the scan islimited to the treatment area in order to reduce the radiation amountexposed to the patient. FIG. 2, which is an illustration of a CBCT scan,shows an example of the patient's dentition.

If a tooth, which is compromised and will be replaced with a dentalimplant, is already out of the mouth, an optical scan of the tooth canbe done to generate a 3D data set. The data can be used later forgenerating a customized abutment.

At step 104, a tooth of the patient is extracted and prepared to providea root part. For example, the root of the extracted tooth is resectedaccording to predetermined requirements to provide the root part havingautologous tissue attached thereon. FIG. 3 is a virtual segmentationshowing an example of the extracted tooth having a root part that willbe separated from the extracted tooth. During this procedure, to preventpotential fractures of the thin cortical bone layer in the anterior orpremolar region at the time of extraction, a vertical extraction forceis applied with very limited extra axial movements. The tooth extractionis performed as atraumatic as possible to avoid damage to the alveole.

After extraction, the tooth is intensively rinsed with a flow of sterileisotonic saline and can later be stored in a tissue culture medium atroom temperature. An example of tissue culture medium is the toothrescue box Dentosafe™ (Dentosafe GmbH, Iserlohn, Germany) can used,which is readily available. This medium maintains the vitality andproliferative capacity of periodontal ligament (PDL) cells for at least48 hour in vitro and in vivo. During the storage period, an extra-oralendodontic treatment can be performed. To separate a part of the root ofthe extracted tooth, the root can be resected according to specificneeds and planning of the dental implant procedure. For example, a rootsurface of minimum 2-3 mm is maintained. In this process, the autologoustissue, particularly the periodontal connective tissue such as PDLcells, is clinically preserved to maintain its vitality. The periodontalconnective tissue, which will be eventually attached to the coronalparts of the abutment, provides most of the advantages that aperiodontal connective tissue attachment confers on the naturaldentition. Thus, as the periodontal connective tissue is connected to anabutment made of titanium, zirconium or PEEK, the tissue is capable ofmaintaining the cortical crestal bone without any significant hardtissue loss. As a result, the soft tissue level can be supported and anormal periodontal healing can be expected similar to the healingprocess after intentional replantation.

At step 106, the data resulting from the X-ray scan are imported into acomputer, a processor or the like, which is capable of maintainingdatabase and implementing a predetermined algorithm, such as CAD/CAMsoftware. In this step, the data is processed by the computer togenerate a customized abutment, to which the separated root part will beattached. During this procedure, a model of the customized abutment isfirst generated by the computer and, subsequently, either ceramic,acrylic like PEEK or PMMA, titanium or a metal-free zirconium materialis machined based on the model to complete the customized abutment. Thecustomized abutment is configured to match the extracted tooth in form,and accordingly, does not alter the underlying anatomy of the extractionsocket, nor require any additional surgical intervention. For example,the surface of the abutment can be configured to be comparable tocustomized and market-available implant abutments (such as, Atlantis™from Dentsply Implants of Tulsa, U.S.; or Procera™ from Nobel Biocare ofGothenburg, Sweden). FIG. 4 is a bottom perspective view, showing asimulated abutment having a customized base plate fitting precisely tothe shape of the extracted tooth root. The customized abutments are alsocalled Custom or Computer Milled Abutments (CMAs). CMAs can be producedbefore or after the implant has been placed. The CAD/CAM system allowsboth the dentist and the laboratory to request a site specific abutmentfor the patient in collaboration with a design/manufacture team.Preferably, state-of-the-art software and milling machines utilize scandata from the patient to fabricate a computer-generated abutment milledto precisely match the depth, angle and orientation of the implant andthe connected natural tooth. The CMAs are available for almost allimplant platforms with extreme precision. These abutments are fullymilled from a block of titanium, goldplated titanium, zirconium, PEEK oracrylic material, making them extremely strong, compatible with aspecific implant, and without the inaccuracies inherent in a lost waxmethod. Site specific instructions detailing key design features such asmargin levels and emergence contours can be provided by the dentist,along with an opposing cast and bite record.

As the average diameter and shape of human teeth are well known, astandard prefabricated abutment can be used as an alternative. For everytooth in the jaw, a specific standard abutment would be available,matching this tooth specific root/crown contour and form and finallydelivering a customized abutment connected to the extracted naturaltooth segment.

Standard prefabricated abutments (such as, titanium abutments) aresupplied by dental implant manufacturers to match their implants. Thestandard prefabricated abutments are also known as preparable or direct,as they are available in a variety of shapes and sizes. Angulations ofthe abutments may be adjusted or modified manually, either at thelaboratory or in the clinical office, to adapt the shape according tothe position of the implant and the patient's individual anatomy. Thestandard prefabricated abutment can be used (after minor adjustment ifnecessary) for the novel autoalloplastic abutment as disclosed by thepresent disclosure, which is connected to the coronal part of a naturaltooth, given that the average form of every human tooth is taken intoconsideration and a number of different stock abutments are madeavailable for the clinician. During a clinical treatment, the dentistselects a suitable standard prefabricated abutment, which fits best tothe existing clinical situation.

Alternatively, Custom Cast Abutments (CCA) or UCLA abutments can also beused for the novel autoalloplastic abutment as disclosed by the presentdisclosure. An accurate impression identifies the implant position inall three planes of space. The impression is transferred directly to thelaboratory where the technician fabricates a stone or plaster model andplaces in it an implant analog. This model and analog preciselyreplicates the clinical orientation and position of the implant asobtained directly from the patient's mouth. A prefabricated plasticwaxing sleeve is placed in the analog and is subsequently sculpted bythe technician in wax to establish proper internal fit and adaptation tothe implant platform. The technician subsequently refines the waxpattern to permit the development of optimal contours and emergenceprofile of the abutment as well as the future implant restoration. Thismethod permits the technician to correct for imperfect implant positionsand angulations, as well as controlling the alignment of multipleimplant abutments. The CCA and UCLA abutments are restorativealternatives that would enable clinicians to deliver a customizedabutment connected to the natural tooth.

Alternatively, Customized Abutment with Prefabricated Elements (CAPE)can also be used for the novel autoalloplastic abutment as disclosed bythe present disclosure. For example, an important aspect of an implantabutment is the mating surface that forms part of the implant-abutmentconnection. The design of the fitting surface and mode of abutmentmanufacturing will influence the precision of fit between the implantand abutment. Several issues have been identified with abutment misfitand microgaps for fully customized abutments. To justify the use,CAD/CAM customized abutments should be able to produce a degree of fitcomparable with proprietary produced standard abutments. One reason forthis problem is that milling machines are utilized for the manufacturingof fully customized abutments. For standard abutments mostly turningmachines are used which result in a much higher accuracy compared tomilling machines. The disadvantage of turning machines is the lack offree form customization, which is necessary for fully customizedabutments. Therefore, the idea is to integrate both machiningtechnologies for the production of an implant abutment, that isprefabricated in the important area of the implant-abutment connectionand can be customized in the coronal area, where the ability to mimicthe existing clinical situation is more important than absoluteaccuracy. The implant-abutment connection for every implant system isnow prefabricated with a turning machine resulting in a highly precisesurface comparable to the standard abutments and only the coronal partof the abutment will be customized with a milling machine, a lasersintering process or a 3D printer according to the clinical needs.

At step 108, the generated abutment is cleaned, for example, in anultrasonic bath containing 96% ethanol for 10 min, packaged andsterilized in a steam sterilizer.

At step 110, a root canal treatment is performed from the apicaldirection of the extracted tooth after a standardized preparation of theroot canal, and the root canal treatment is implemented through specialdrills offering 4 different diameters (such as, Retropost™ ofBrasseler-Komet, Lemgo, Germany). At the same time, the root surface isnot manipulated or processed, in order to achieve a periodontalconnective tissue attachment formation.

In this procedure, the drills (or burs) and the root are intensivelycooled with physiologic saline. The root canal is prepared from the apexbeyond the most coronal aspect of the cemento-enamel junction. Due tothe conical shape of the root canal, a generally wide preparation isrequired to secure a complete root canal preparation, including themarginal region of the root.

At step 112, a connecting structure of the abutment (for example, anabutment post 218 shown in FIG. 5, which will be described later) isattached to the tooth structure which is resected from the extractedtooth of a patient. For example, this step can be implemented by fittingthe abutment post into the root canal. The length and dimension of theabutment post can be determined based on needs. For example, for apermanent incisor, the abutment post can be configured to allow at least2-3 mm of the natural root surface. The intra-canal part of the abutmentpost is roughened to enhance cementation. After drying of the root canalthrough sterilized paper points, the post is cemented into the rootcanal with endodontic sealers to attach the extracted tooth/root parthaving autologous tissue (such as, PDL cells) to the abutment.Alternatively, the tooth having autologous tissue can be screwed on theabutment. During an initial setting for about 2-3 min in the air, theperiodontal ligament is kept moist using sterilized paper points soakedin tissue culture medium. For primary canines, they are again stored inthe tissue culture medium for at least 10 min for further setting of thesealer. Thereafter, excess sealer is removed using small excavators andsterilized dental floss. The prefabricated or customized abutment andthe autologous tissue provide an embodiment of an autoalloplasticabutment.

At step 114, a dental implant is placed. For example, the dental implantcan be Ankylos™ dental implants (Dentsply Implants, Tulsa, U.S.A.),which are placed according to the manufacturer's manual. The implant bedpreparation and the implant placement is done minimal invasive, andparticularly, the coronal bone and soft tissue is not touched. Thediameter of the implant is chosen to be slightly smaller than thecoronal diameter of the extraction socket, as this prevents damage tothe connective tissue in this area. The length of the implant can bechosen to be longer than the extraction socket to gain primarystability.

The Ankylos™ implant is placed, for example, 2-3 mm subcrestally, toallow the formation of a periodontal connective tissue attachment. TheAnkylos™ implant is FDA approved for subcrestal placement and primarystability can be achieved as checked by palpation and percussion.

At step 116, the abutment is tightly connected to the implant. In thisstep, the remaining tooth root is cemented on the prepared customizedabutment or prefabricated standard abutment. FIG. 5 illustrates theimplant and the customized abutment, prior to the connection of theabutment to the implant. FIG. 6 illustrates the implant and thecustomized abutment (with the root part attached thereto), after theconnection of the abutment to the implant. After the placement of theimplant and the connection of the autoalloplastic abutment to theimplant, it is desirable that the cemento-enamel junction of the toothroot cemented on the customized abutment is ideally placed slightlybelow the osseous margin of the alveolus, which can achieve the aim ofpositioning the transplant without strong contact to the bone of thealveolus. Prior to the final insertion of the combined transplant, thetransplant and the transplant bed are intensively rinsed with sterileisotonic saline. Also, a customized splint (not shown in the figures),designed in accordance with the patient's lingual or vestibular anatomy,can be attached to the transplant, if there is a need to do so. Thesplint can provide primary stability and placement accuracy during boneintegration, and loading of the implant directly after insertion isavoided. The splint is normally removed after 2-6 weeks.

Now referring back to FIGS. 4-6, an abutment 200 according to anotheraspect of the disclosure will be described. The abutment 200 includes anapical end 202 and a coronal end 204 opposite the apical end in theextending direction of the elongated abutment. At the apical end 202,the abutment 200 includes an insertion portion 206, which is designed tobe received in an opening of a dental implant 300. The insertion portion206 can have an anti-rotation profile 208, which for example includes aplurality of recesses 210 and projections 212 arranged alternately. Theabutment 200 further includes a transition portion 214 arrangedcoronally of the anti-rotation profile 208. The transition portion 214is, for example, is conically shaped to provide a better appositionbetween the abutment 200 and the dental implant 300. The abutment 200further includes a shoulder portion 216 arranged coronally of thetransition portion 214, and a connecting portion 218 extending coronallyfrom the shoulder portion 216. The connecting portion can be in the formof a post. The shoulder portion 216 is customarily configurable to matchthe analogue of the extracted autologous tooth. A root part preparedfrom the extracted tooth, as identified by numeral 400, can be connectedto the shoulder portion 216 or the post 218 to provide a final abutment.The abutment 200 is, for example, generated by step 106 of the method100 as discussed above. Specifically, the shoulder portion 216 and/orthe post 218 are/is configured to match the analogue of the autologoustooth, such that when the separated tooth root part 400 is cemented tothe abutment 200 during the procedure, there is no need to alter theunderlying anatomy of the extracted socket and there is no requirementof any additional surgical intervention. The customized abutment 200 canbe manufactured through machining a stock abutment which hasprefabricated features for dental implantiabutment connection andabutment/tooth part connection, respectively. For example, a stockabutment can be selected to have a prefabricated connecting portion(such as the post 218) which is used to connect to a tooth part andanother prefabricated connecting portion (such as the insertion portion206 and/or the transition portion 214) which is used to connect to adental implant. In order to provide the customized abutment, the middleportion of the selected stock abutment is processed through subtractiveand/or additive machining to provide a customized emergence profile(such as the shoulder 216), which is capable of matching the dentalanalogue of a specific patient.

The periodontal cells of the root can be kept vital for up to 48 hoursdue to the use of a special cell culture solution. In case of trauma, itwill be possible to extract the compromised tooth and to keep the cellsalive as long as necessary to produce the root shaped implant abutment.

The natural root provides a source of periodontal regeneration-competentcells in the postsurgical wound-healing environment, which is able toreconnect to the bone and soft tissue. The combination of a dentalimplant with a customized abutment fitting exactly to the autologousroot tissue can reduce the overall treatment time dramatically byvertically stabilizing all surrounding tissues at the same time.

The clinical significance of the methodology is that the formation of aperiodontal connective tissue attachment on the coronal parts of thedental implant abutment would provide most of the advantages that aperiodontal connective tissue attachment confers on the naturaldentition. The periodontal connective tissue attachment on the naturalroot surface connected to titanium, zirconium or PEEK abutments afterimmediate implant placement can potentially maintain the corticalcrestal bone without any significant hard tissue loss. Consequently, thesoft tissue level can be supported and the attachment type can besimilar to a natural tooth; and a normal periodontal healing can beexpected similar to the healing process after intentional replantation.

The clinical effect of the methodology is that the apical portion of theimplant would osseo-integrate with the surrounding bone and the coronalportion with the remaining root attached to the implant abutment wouldform a natural connective tissue attachment. This can change the coronaltissue stability especially between two implants. Even after removal ofthe remaining root from the abutment or exchange of the completeabutment after the healing period, the extraction socket with theimmediate implant placement has already been healed and the remainingwound surface has been minimized resulting in stabilized surroundingtissue.

While the fundamental novel features of the disclosure as applied tovarious specific embodiments thereof have been shown, described andpointed out, it will also be understood that various omissions,substitutions and changes in the form and details of the devicesillustrated and in their operation, may be made by those skilled in theart without departing from the spirit of the disclosure. For example, itis expressly intended that all combinations of those elements and/ormethod steps which perform substantially the same function insubstantially the same way to achieve the same results are within thescope of the disclosure. Moreover, it should be recognized thatstructures and/or elements and/or method steps shown and/or described inconnection with any disclosed form or embodiment of the disclosure maybe incorporated in any other disclosed or described or suggested form orembodiment as a general matter of design choice. It is the intention,therefore, to be limited only as indicated by the scope of the claimsappended hereto.

1.-11. (canceled)
 12. A method of manufacturing an abutment for a dentalimplant, the method comprising: obtaining data associated with thedentition of a patient; generating a model of the abutment through acomputer-implemented process based on the data; and processing amaterial based on the model to generate the abutment, wherein theabutment is configured to match the analogue of a predetermined tooth ofthe patient, such that, after the predetermined tooth is extracted andprepared to provide a root part, the root part is attached to theabutment during osseointegration.
 13. The method of manufacturing anabutment of claim 12, wherein the data used is based on the averagehuman tooth size and shape, such that the abutment can be prefabricated.14. The method of manufacturing an abutment of claim 12, furthercomprising cleaning and preserving the abutment.
 15. An abutment for adental implant, the abutment comprising: an apical end and a coronal endopposite the apical end; an insertion portion at the apical end, theinsertion portion being configured to be received in an opening of thedental implant; a transition portion coronal of the insertion portion;and a connecting portion extending coronally of the transition portion,wherein the connecting portion is configurable to be attached to a rootcanal or tooth structure of an extracted tooth of a patient.
 16. Theabutment of claim 15, wherein the insertion portion comprises ananti-rotation element, the anti-rotation element having a plurality ofrecesses and protrusions arranged alternately.
 17. The abutment of claim15, wherein the transition portion has a conical shape.
 18. The abutmentof claim 15, further comprising a shoulder portion coronal of thetransition portion, wherein the shoulder portion is customarilyconfigurable to match the analogue of the extracted tooth of thepatient.
 19. The abutment of claim 15, wherein the abutment ismanufactured using a CAD/CAM process.